الفهرس 
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Abstract
Head and neck cancer (HNC) is considered to be the sixth most common cancer with the seventh highest cancer mortality. According to the Egyptian Society of Head and Neck Oncology (ESHNO) statistics, 4,000 Egyptians fall victim to these types of tumors every year, among which almost 1,900 die. The most commonly listed cause of HNCs are tobacco and alcohol abuse, other reasons include exposure to different HNC-inducing agents, such as bethel chewing, hot tea, human papilloma viruses.
Neck dissection is the surgical treatment of many patients with cancer of the head and neck. Head and neck surgery often includes dissection of the lateral cervical lymph nodes, usually on the disease side, but sometimes bilaterally. Shoulder dysfunction, Cosmetic deformity, parasthesia, and chronic neck and shoulder pain syndrome are well recognized complications of neck dissection that affect long-term quality of life (QOL).
Rehabilitation refers to a process aimed at enabling persons with disabilities to achieve and maintain their optimal physical, sensory, intellectual, psychiatric, and social functional levels; the rehabilitation of these patients, it is of primary importance to unload the shoulder immediately post operatively, reduce shoulder and neck pain, and prevent stretch fibrosis of the muscles, as well as to provide strengthening exercises for the residual muscles in the neck and shoulder girdle to compensate for lost muscles.
The aim of this study was to assess the effect of a nursing rehabilitation program on patients’ health outcomes and quality of life after neck dissection for tumor removal.
Materials and method:-
• Materials:
The study was carried out at the head and neck surgery unit in the Alexandria Main University Hospital. Subjects of this study were a convenient sample of 40 adult patients with the diagnosis of head and neck cancer; and scheduled for neck dissection surgery. They were assigned to 2 equal groups, control group(I) :who were subjected to routine hospital care , and a study group(II):was exposed to a proposed nursing rehabilitation program , (20 patients in each).
Three tools were used to determine the effect of a nursing rehabilitation program on patients’ health outcomes and quality of life after neck dissection for tumor removal. Tool I: quality of life after radical neck dissection questionnaire. This tool was used to assess the head and neck cancer patients’ health status before and after Implementation of the rehabilitation program for the patients, it consisted of three parts; part I: The defining characteristics questionnaire consisted of two different sections: The first section: questions regarding socio-demographic information of the patients’, The second section: questions regarding clinical condition. Part II: related to Health-related quality of life (HRQOL), Part III: it includes three global questions related to overall QOL. Tool II: Physical Exam Record; This tool used to assess and document the following variables: myofascial pain of the levator scapulae, joint pain of the acromioclavicular joints, allodynia, loss of sensibility, active shoulder abduction and Muscle testing. Tool III: Patients’ Health Outcomes; it was used to assess: The primary endpoint of the study is motor/mobility recovery at two months, and secondary outcomes are quality of life
Method:
Adult patients who fulfilled study subject inclusion criteria were assigned sequentially and equally into two groups 20 patients each, immediately on admission. Bio-socio-demographic and clinical data were obtained from all patients participating in both groups on the first day of admission. Patients in the control group I was only exposed to routine hospital care as carried out by ward medical and nursing staff. A proposed nursing rehabilitation program was carried out by the researcher at the study setting to each patient in the study group II and reinforce it on the preoperative, first two weeks, and 2nd months postoperative, using verbal instructions and colored booklets.
The illustrated colored booklet was distributed to each patient as a reference. Patients of the study group were asked to bring one of the family members to attend the teaching. Patients in the experimental group were managed and followed before surgery. Preoperative measures included; assessment, and preoperative preparations. Postoperative care until discharge included; the exercise program was conducted weekly at 2 phases for 2 months, About 30 minutes for each session. The first 2 weeks post operative; the patient was cognizant of proper positioning for the affected shoulder and neck area. While the patient seated, the shoulder and the upper arms were supported on a pillow or arm chair to prevent further stretching of the trapezes. The start of the exercise program delayed approximately 2 weeks after surgery to avoid delayed wound healing or fistula formation and danger of carotid “blow out”. Therapeutic exercises were initially passive but gradually progress to active- assistive and eventually resistive exercises as tolerated by the patient. Therapeutic exercises include cervical exercises (active cervical ROM exercises, isometrics); shoulder exercises (Active ROM, Strengthening); swallowing exercises; tongue base strengthening exercises; and mouth exercises.
Evaluation phase was carried out after 2months postoperative, it included, re-evaluation by the researcher using tools I, II, and III after implementation of the nursing rehabilitation program to determine the effectiveness of rehabilitation program on patients’ health outcomes and Quality of life, Comparisons of the pre and postoperative neck dissection surgery patients, presence of problems/complaints, were carried out, Satisfaction with the provided nursing care was determined, Patient pain reassessment, and Postoperative neck dissection surgery patients expected outcomes were determined.
The main results of the study were:
1- The majority of the patient’s age in both of the control and study groups (i.e. 55.0 %-30.0%, respectively) were among 50 < 60 years of age.
2- Males were the highest percentage of patients in the control group,(i.e. 55.0% ), while there were equal percentage of male and female patients in the study group (i.e. 50.0%, respectively)
3- Laborers represented the highest percentage of patients in both the control group (i.e. 40.0%).
4- Secondary school graduates formed the greatest proportion of the sample in both of the control and study groups (i.e. 40.0% - 30.0% respectively).
The highest percentage of patients in the control and study groups were married (i.e.60.0 % and 70.0% respectively).
6- More than half of the sample in the control group and the study group (i.e.50.0 %, 56.0%) were from rural areas.
7- The highest percentages were diagnosed as thyroid cancer with right, left or bilateral lymph nodes metastasis of the controls and of the study group subjects (50.0%, 45.0%).
8- More than half of the sample in the control group and the study group had been undergone modified neck dissection surgery (i.e. 55.0% and 65.0%, respectively).
9- Patients in the control group and the study group did not suffered from any medical conditions (i.e. 50.0% and 45.0%).
10- Patients in both the control and study groups had not previous head and neck surgeries (i.e. 85.0%).
11- There were low family history incidence for head and neck cancers in both controls and studied subjects (i.e. 100.0% - 90.0%).
12- The highest percentage of patients in both control and study groups were receiving radiotherapy (i.e. 50.0% and 35.0%, respectively).
13- Statistically significant differences between the control and study group patients regarding, the pain were elicited on the two months postoperative, since p=0. Statistically significant differences in the control patients regarding, the body pain were elicited on the 2nd months postoperative, than on the preoperative, since p=0. While there was no statistical significant differences, in the study patients, since p=0.373, respectively.
14- Statistically significant differences between the control and study group patients regarding appearance on the two months postoperatively, could be detected as p= 0.001 respectively.
15- Statistically significant differences between the control group patients and the study group patients regarding activity on the 2 months postoperative, since p= 0.
16- There was statistical significant differences between the control group patients and the study group patients regarding the recreation on the 2 months postoperative, since p= 0.
17- Statistically significant differences between the control and study group patients regarding, the swallowing were elicited on the two months postoperative, since p=0.
18- There were statistical significant differences between the control group patients and the study group patients regarding chewing on the 2 months postoperative, since p= 0.
19- There were no statistical significant differences between the control group patients and the study group patients regarding the speech on the 2 months postoperative, since p= 0.061.
20- There were no statistical significant differences between the control group patients and the study group patients regarding the taste on the 2 months postoperative, since p= 0.158.